Understanding Sarcopenia: The Battle Against Age-Related Muscle Loss
As we age, maintaining our physical strength and functional abilities becomes increasingly important. One of the crucial aspects of this is understanding sarcopenia, which is the age-related loss of muscle mass and function. In this article, we will explore what sarcopenia is, its implications for longevity, and practical strategies to combat its effects. I had the pleasure of sitting down with Justin Keogh who is the Associate Dean of Research for the Faculty of Health Science and Medicine at Bond University, with a special interest in geriatric exercise prescription who helped me understand this area better and write this guide to help you maintain muscle health as you age.

What is Sarcopenia?

Sarcopenia is defined as the progressive loss of muscle mass, strength, and function associated with aging. It is not merely a consequence of getting older; rather, it significantly impacts independence and quality of life. As muscle mass decreases, older adults often find everyday activities more challenging. Tasks like standing up from a chair, walking, or climbing stairs become increasingly difficult. Contemporary definitions of sarcopenia encompass not only muscle mass but also muscle strength and physical performance. Physical performance can be gauged through assessments such as gait speed and the ability to perform sit-to-stand activities. These metrics are used because the movements offer a proxy for fundamental movements for maintaining independence and functionality in daily life.

The Importance of Muscle Health in Aging

Taking steps to maintain and enhance muscle strength as we age is important for several reasons. Loss of muscle mass can lead to:
  • Increased risk of falls
  • Reduced mobility
  • Decreased overall strength
  • Lower metabolic health

How Does Muscle Loss Affect Longevity?

One of the key questions surrounding sarcopenia is its relationship with longevity. Studies have shown that individuals who lose muscle as they age may not only experience functional decline but may also have a higher risk of premature death. For instance, walking speed has been identified as a significant biomarker of longevity. A gait speed of less than 0.8 meters per second is associated with increased negative health outcomes aka not living as long as you might.  As walking speed decreases, the risk of severe health consequences and mortality increases. Therefore, maintaining muscle strength along with function is paramount for promoting longevity.

Factors Contributing to Sarcopenia

Sarcopenia can result from various factors, including:
  • Reduced physical activity
  • Hormonal changes
  • Chronic diseases
  • Malnutrition
These factors can compound over time, leading to significant muscle loss. It is crucial to address these elements proactively to mitigate the effects of sarcopenia.  You might do this with your doctor, nutritionist, chiropractor or osteopath, but whomever you work with make sure they have skills in working with an elderly population. 

Strategies to Combat Sarcopenia

To effectively combat sarcopenia, a multifaceted approach is required. Here are some practical strategies: 1. Engage in Resistance Training Resistance training is one of the most effective ways to maintain and build muscle mass. Engaging in strength training exercises at least twice a week can help counteract muscle loss. Focus on exercises that target major muscle groups, which can start with things like getting up and down from a chair and progress to:
  • Squats
  • Lunges
  • Push-ups
  • Rowing
2. Incorporate Balance and Flexibility Exercises Improving balance and flexibility is crucial for functional mobility. Incorporate exercises such as:
  • Tai Chi
  • Yoga
  • Dynamic stretching
These activities can enhance stability and coordination which increase the brain's control of your muscles.  This can reduce the risk of falls. 3. Optimize Nutrition A well-balanced diet rich in protein is essential for muscle repair and growth.  For most people as they age their protein requirement actually goes up.  This is due to difficulty absorbing some proteins as the intestines age. So, aim to include for following foods in your diet. 
  • Lean meats
  • Dairy products
  • Legumes
  • Nuts and seeds
Consuming adequate amounts of protein can help maintain muscle mass as you age. 4. Maintain an Active Lifestyle Incorporating physical activity into your daily routine is vital. Consider activities such as:
  • Walking
  • Gardening
  • Dancing
  • Swimming
These activities can help sustain muscle health and improve overall fitness levels.  In some communities they have exercise classes specifically for an elderly population.  For example my mother, who is currently 86 regularly attended a group exercise class for the elderly in the UK.  She does this with friends and finds it a really good way to socialize as well as exercise.  5. Use Movement Snacks For those struggling to find time for formal exercise, "movement snacks" can be an effective solution. This concept involves integrating short bursts of physical activity into your day. Examples of movement snacks include:
  • Doing calf raises while cooking
  • Performing squats while watching TV
  • Taking the stairs instead of the elevator
  • Standing on tiptoe while brushing your teeth.
These small actions can accumulate significant benefits for muscle health.

Addressing Common Concerns

Many individuals may question whether they can still gain muscle mass as they age. Dr. Keogh says that while it is more challenging, it is certainly possible, especially for those who are new to resistance training. Older adults can experience significant strength gains and improvements in functional capacity. It is essential to start with a manageable routine and gradually increase the intensity. Consulting with a fitness professional can help tailor a program that meets individual needs and goals. Understanding and addressing sarcopenia is critical for promoting longevity and maintaining a high quality of life as we age. By engaging in resistance training, optimizing nutrition, and incorporating physical activity into our daily routines, we can combat the effects of muscle loss. Remember, it is never too late to start prioritizing your muscle health—every effort counts towards enhancing your health span and lifespan. For more information on muscle health and effective strategies to combat sarcopenia, reach out to me via the Contact Page and we’ll see if we can start making Your Lifestyle Your Medicine.
Navigating Scoliosis: Understanding Your Options Beyond Surgery
The shock of discovering scoliosis can be very sudden.  Adolescent Idiopathic Scoliosis can feel like it comes on overnight, one day it isn’t there then the next day it is.  Or course it doesn’t happen like this but when parents notice it for the first time it seems like it does.   If you are like most people, you’ve gone home and googled it. And what do you read? Most likely you start by reading the definition: Scoliosis is a condition that causes the spine to curve to the side. It can affect any part of the spine, but the most common regions are the chest area (thoracic scoliosis) and the lower section of the back (lumbar scoliosis). Idiopathic scoliosis has no known cause. That doesn’t tell you much, so you dig a little further and see something like this from the Mayo Clinic: “If a scoliosis curve gets worse, the spine will also rotate or twist, in addition to curving side to side. This causes the ribs on one side of the body to stick out farther than on the other side. Problems with Appearance. — including unlevel shoulders, prominent ribs, uneven hips, and a shift of the waist and trunk to the side “Complications can involve lung and heart damage, back problems.” This doesn’t sound good…you don’t know if you or your child's spine will get worse, get better, or just stay the same. Your doctor will probably ask for some x-rays. Once they come back, they will measure the change in degrees of your spine from straight to bent, called the Cobb Angle and depending on how severe the curve is, they will give you three options:
  1. Wait and see what happens to the angle of the curve.
  2. Bracing
  3. Surgery
This is pretty typical of modern medicine. They have to draw a line in the sand somewhere, but it doesn’t take into account all the other types of therapy you could try.  Viewing scoliosis simply as an unwanted curvature in the spine means it seems logical that correction is the only solution. For example, if I’m a surgeon trained to fix physical issues through surgery, how would I want to fix a curve? Most likely, I would recommend surgery. A review of the history of surgery for scoliosis by Carol Hasler in the Journal of Children’s Orthopaedics (1) points out that when the methods used in scoliosis surgery are compared to other orthopedic surgeries such as hip and knee replacements, it is stigmatized by the medical world as ‘a rather archaic way of sacrificing function in young and otherwise healthy individuals.’ However, it’s come a long way from the way Galen and Hippocrates used to treat scoliosis. In the 1950s, a surgeon named Paul Harrington pioneered a procedure that corrected the side bending of the spine by cutting people along the length of their back and inserting metal rods. It’s been estimated that between 1960 and 1990, about one million people had this surgery. However, it’s no longer used in the original format because it came with numerous problems.  For example, the rods had a tendency to  break resulting in more operations.   Historically, surgeons didn’t consider the spine as a three-dimensional structure, meaning it moves forward and backward, side to side, and rotates both ways. This resulted in the areas on either end of the rod being overworked, wearing out, and developing arthritis.

Modern Surgical Techniques

During the 1970s and 80s, surgery was developed to work with the three-dimensional nature of the spine by using wires, hooks, screws, and rods. These procedures were refined during the 90s, but still, new surgeries were created due to the shortcomings of the wires, hooks, and rods. More recently, surgeons offer osteotomies (removal of parts of the bone), vertebral body resection (removal of the vertebra), and most recently, vertebral tethering, in which a surgeon essentially takes some cord and tacks it between two vertebrae on the the long side of the curve. As the person grows, it creates tension and straightens the spine. Some of these modern surgeries aim to preserve the ability of the spine to function or express movement in young people which is a huge leap forward from the rods. 

Before You Commit to Surgery

Don’t get me wrong, I’m not against surgery. But before we commit to a procedure from which there is no turning back at such a young age, we need to ask some pretty deep questions.
  • At what point do you need surgery, and what happens if you don’t have it?
Ask your doctor 
  • At what curve angle is surgery medically necessary due to heart or lung problems? 
You’ll be surprised by the answer.
  • Ask them what happens if you don’t have surgery?
  • Ask them what problems can be caused by the long term loss of motion in the spinal joints after surgery?
If you are not considering surgery then you should look into bracing and exercise. Bracing has been shown to be effective(2) in halting curve progression and exercise can be used in combination with bracing or by itself to slow down, stop or reduce curves. Exercise, in some but not all cases,  is also a great way to reverse the curve. For example, Charlotte, at 12 years old, had a curve of 25 degrees, and in just 3 months reduced it by 10 degrees by following the Scoliosis Protocol.   Scoliosis specific exercises can be done in water, with a kinesiologist, physiotherapist, osteopath or chiropractor.  Depending on your age you may also want to consider dietary changes or supplements and more passive therapies like massage and foam rolling.  These can help the symptoms of scoliosis which are pain and fatigue and are more common in adults than teens.  The takeaway here is that your doctor might not even mention other approaches and instead just focus on the angle of the curve and surgery, when specific exercises in adolescence and adulthood can slow down, stop or even reverse the progression of scoliosis. If you would like to receive my FREE E-book on the 7 Secrets of Scoliosis join the Public Scoliosis Correction Protocol Group here and download it once you join: https://www.facebook.com/groups/351414238781617/ Sources:
  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3566253/
  2. https://www.nejm.org/doi/full/10.1056/NEJMoa1307337
The Difference Between Chiropractic, Physiotherapy and Osteopathy
Many people ask us how osteopathic therapy is different from physiotherapy, chiropractic care, or massage. The answer to that question doesn’t neatly fit into one line.

Let’s start with the similarities:

Osteopathic therapy, physiotherapy, chiropractic care, and massage share a common philosophy: The integrity of the spine is important in ensuring good health. In fact, this philosophy is shared by almost all traditional healing arts, including yoga, tai chi, and chi gong. It is also found in many modern complementary and alternative treatment modalities, including Alexander Technique and Structural Integration, which is also known as Rolfing.  The way some chiropractors and physiotherapists practice is very similar to the way osteopaths practice and visa versa.  So, I’m going to make some generalities here, and that may upset some folks, but if you are good at what you do there is no need to take offense, just continue doing what you do and do it well. 

Now for the differences:

Generally, people are motivated to seek a therapist because of pain or impaired movement. Let’s look at how different types of therapists might treat the same problem. Imagine you have a shoulder injury. You play recreational golf, and each year, at the beginning of the season, you get a twinge in your shoulder. You’d like to play golf pain-free, and you’d like the pain dealt with once and for all.

You try physiotherapy . . .

  • Your treatment time will vary from 15 to 30 minutes.
  • The physiotherapist assesses your shoulder using standard orthopedic tests and reaches the conclusion that there is some impingement of one of the rotator cuff muscles, which is a very common shoulder injury.
  • The therapist might choose to use some ultrasound on your shoulder.
  • You will get some specific exercises to increase strength to any weakened muscles of your shoulder.
  • The treatment may or may not include hands-on work. If it does, it will probably just be focused on your shoulder or upper ribs.
  • You are asked to come back twice a week for eight treatments.

You try chiropractic care . . .

  • Your treatment time will vary from 5 to 30 minutes for your first appointment and, in some cases, just last for about 5 minutes in subsequent sessions.
  • Like the physiotherapist, the chiropractor might assess your shoulder using some standard orthopedic tests. The tests might also include an assessment of your spine, often using X-rays.
  • The chiropractor will examine the parts of your spine where the nerves to the shoulder come out, checking for what they call a subluxation. From the chiropractor's perspective, the spine can become minutely out of alignment, and the resulting subluxations inhibit nerve flow, which can cause joints to become injured.
  • Treatment will probably involve manipulating your spine to free up the nerves so that they can better control your shoulder.
  • You may then be asked to come back two to three times a week for three weeks. This can be a prepaid treatment plan or pay-as-you-go. You will then slowly decrease the frequency of your treatments until you are on some sort of monthly maintenance program to check for general subluxations.

You come to try osteopathic therapy with me. . .

  • Your first treatment lasts one hour. Subsequent treatments last 30-45 minutes.
  • I will assess your shoulder to find out which areas are damaged.
  • I then assess your spine to see if the nerves in your shoulder are compromised. In this way, we are similar to chiropractors.

But here is where it gets interesting.

I will also look further afield because your shoulder does not work in isolation:
  • I assess the quality of movement around some of your internal organs pertinent to your shoulder, including your lungs, liver, and gall bladder. Amazingly, the liver and gall bladder can both cause shoulder pain via a miscommunication in the spine that overlaps nerve feedback from both the shoulder and these organs.
  • I assess other joints that work in conjunction with the shoulder, especially the wrists, elbows, neck, and hips.
  • I might even choose to look at movement patterns. For example, I’d ask you to demonstrate your golf swing technique to see if any restrictions in your hips or neck are placing too much work on your shoulder.
The treatment is both hands-on and movement-based.
  • The hands of an osteopathic therapist are more sensitive and knowledgeable than any type of machine. We don’t use ultrasound or any other devices to help us understand what’s going on.
  • We find we get the best results by keeping the treatment to the work of our trained hands.
  • We are trained to do strong manipulations, joint movements, and massage techniques.
  • We also know how to use our hands in a very subtle way to gently free restrictions around organs and other deep body structures to restore health to your body as a whole.
The course of treatment with osteopathic therapy
  • We might ask you back in one or two weeks.
  • On average, we will want to see you four to six more times over a two—to three-month period to ensure the problem goes away.
  • That will also give us a chance to help you with any other problems we may find that we think will cause you trouble in the future.
What other people say about the differences between manual therapists:
Understanding and Treating Chronic Back Pain: A Multidisciplinary Approach
Chronic back pain is a pervasive issue affecting millions worldwide, particularly among middle-aged adults. It can be debilitating, affecting daily activities, work productivity, and overall quality of life. Understanding the root causes of chronic back pain and exploring a multidisciplinary approach to treatment can offer significant relief and improve well-being.

Causes of Chronic Back Pain

Chronic back pain can be complex, with multiple factors contributing to its development, but it usually starts with a mild injury.  This could be a strain on a muscle or a ligament, or it could come from the disc bulging and pushing on nerves.  Ordinarily, an initial injury would improve in the typical tissue healing time frames, but chronic pain, commonly described as pain lasting longer than 3 months, doesn’t just go away. Pain Science studies the interactions between our body, our mental state, and our environment to help us better understand why a person who should get better sometimes ends up with chronic pain. For many therapists and patients, pain is often seen as a mechanical issue: something is pinching, so it needs to be moved to alleviate the pain. This is why a surgeon might operate on a herniated disc to remove the part pressing on a nerve, aiming to relieve the pain. However, this model doesn't always produce the desired results. For example, it is common to see herniated discs in people who do not have pain (1), and there are well-documented cases of phantom limb pain where the person experiences pain in an area that isn’t even there. Conversely, there are people who have debilitating pain with no visible structural cause seen on MRIs.  So, we can’t say that the ‘mechanical model of injury = pain’ is reliable. Thanks to the research of experts like Gordon Waddell, a spine surgeon who screened patients before surgery for factors that might impede their recovery, we now understand that issues such as lawsuits for compensation, depression, and severe pain without tissue injury can all contribute to chronic pain (2). But why is this?  What is happening in the body to cause this, and what can we do about it? I really like reading the work of the physiotherapist Louis Gifford.  He spent most of his career thinking about chronic pain and how to treat it better.   He used models to help explain some of these complex topics, and one of the models he referred to was the Mature Organism Model or MOM. In this model, the brain is seen as a ‘scrutinizing’ organism that constantly analyzes information from the body, external environment, and memories.  It uses information from these 3 areas and overlays them on our innate evolutionary reflexes to make some decisions.

When it works well, it goes something like this:

A person is running in a race, takes a misstep, and sprains their ankle. The brain processes the pain information from the ankle and compares it to past experiences. This individual has had a mild sprain before that healed quickly, and the current pain feels similar. Assessing the environment, the brain notes that it's only a few kilometers to the finish line, and overcoming the sprain will make for a good story. The person gets up, finishes the race, and feels proud. The next day, the ankle is swollen, but they continue their daily routine, which helps reduce inflammation and keeps the muscles strong. Within a few days, they forget about the injury. The combination of information from the injury, past experiences, and the current environment contributes to a swift recovery.

But how does someone go on to develop a chronic condition?

Consider Dave's situation: he has just slipped at work and is now lying on the warehouse floor, experiencing excruciating back pain that immobilizes him. His brain is processing the pain signals from his back, trying to interpret them, especially since he has never previously injured his back. Recalling his uncle's experience of a work-related slip resulting in long-term disability benefits, Dave begins to fear he has sustained severe damage. The warehouse supervisor notices Dave's distress but lacks experience with back pain, unaware that back injuries often cause more intense pain than injuries to other parts of the body and that pain severity doesn't always correlate directly with the extent of injury. Dave is advised to remain still "just in case it's serious," and emergency services are summoned.  As time passes, Dave's muscles begin to stiffen, worsening his pain. Eventually, he is taken to the hospital, where he receives a clean bill of health and is instructed to rest. However, due to the severity of his pain, Dave remains convinced that something has been overlooked. Luckily, his wife and kids rally around him, and he doesn’t have to lift a finger in the house. However, we might be able to see trouble ahead for Dave for the following reasons:
  1. He’s got a family member who had a bad outcome from an injury to his back at work (negative memories)
  2. His medical team told him to rest, and we have a family that will facilitate that. (Lack of movement)
  3. Dave didn’t really like his job, and his boss told him to take as long as he wanted to recover (No motivation to heal)
  4. A couple of the other lads at work think he should sue for damages. (Motivation to stay in pain)
  5. After a week of rest at home, Dave realizes that his back muscles have weakened, and he experiences nearly constant pain when he moves. Convinced that more rest is necessary, he decides against returning to work and contemplates legal action (Negative association between movement and pain)
  6. No one at work really misses Dave, and they don’t contact him to see how he is doing, and he feels depressed by that. (Depression can lead to increased sensation of pain).
Can you see how this is setting Dave up for chronic pain? What is the best way to help Dave?

A Multidisciplinary Approach to Treatment

Treating chronic back pain often requires a comprehensive, multidisciplinary approach.  This could be delivered by a team of healthcare experts, or many of these components could be delivered by a well-trained therapist.

Here are some key components of such a strategy:

  1. Exercise Therapy: Most therapists offer a structured exercise program tailored to the individual to improve flexibility, strength, and endurance. According to a study published in the Journal of Orthopaedic & Sports Physical Therapy, exercise therapy is a cornerstone in managing chronic back pain (3).
  2. Medical Management: This can include medications for pain relief, such as nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, or even corticosteroid injections for severe pain. A review in The Lancet highlighted the role of combination pharmacotherapy in managing chronic pain, emphasizing the importance of individualized treatment plans (4).
  3. Cognitive Behavioral Therapy (CBT): As we can see, chronic pain is not just a physical experience but also a psychological one. CBT can help manage the mental health aspects of chronic pain. Research published in Pain Medicine indicates that CBT can effectively reduce pain and improve psychological outcomes for chronic pain sufferers (5).
  4. Complementary Therapies: Practices such as osteopathy, acupuncture, chiropractic care, and massage therapy can provide additional relief, but it’s important to understand that a good therapist wouldn’t just deliver massage or manipulation without addressing all the other components listed here.
  5. Lifestyle Modifications: Weight management, proper posture, quality sleep, and stress reduction techniques can all help reduce chronic back pain.

The Importance of a Personalized Approach

Chronic back pain can significantly impact your life, but understanding its causes and exploring a multidisciplinary approach to treatment can make a substantial difference. By combining physical therapy, medical management, cognitive behavioral therapy, alternative therapies, and lifestyle modifications, you can effectively manage and alleviate chronic back pain.  If you want to discuss your specific situation with me, please contact me via the Contact Us page. We'll see if we can make 'your lifestyle your medicine.' References:
  1. https://www.ncbi.nlm.nih.gov/books/NBK441822/#:~:text=In%20many%20instances%2C%20the%20herniation,six%20weeks%20of%20persistent%20symptoms.
  2. https://aci.health.nsw.gov.au/networks/eci/clinical/clinical-tools/orthopaedic-and-musculoskeletal/acute-low-back-pain#:~:text=Whilst%20the%20presence%20of%20red,term%20disability%20and%20work%20loss.
  3. https://www.jospt.org/doi/10.2519/jospt.2021.0304
  4. https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(13)70193-5/abstract
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5999451/#:~:text=Previous%20studies%20have%20shown%20that,%2C%20stress%2C%20and%20chronic%20pain.&text=Additionally%2C%20CBT%20has%20been%20reported,pain%2C%20arthralgia%2C%20and%20fibromyalgia.